Approach to family assessment and intervention

Family studies are an integral part of teaching of community medicine to all undergraduate medical and nursing students. It enhances the understanding of students about social determinants and multifactorial causation of disease. However, there is no standard approach towards it and it is seen as a clinical presentation with some elements of family included. We describe a systematic and comprehensive approach to a family study.

Based on the existing literature and personal experience, we identified 11 domains under the acronym Family ASSESSMENT-Structure, Socioeconomic, Sickness, Nutritional, Educational, Environmental, Affordability, System (health), Mental, Family influence, Threats. Under each domain, we present indicative diagnoses and possible solutions. We also suggest that these domain diagnoses can be integrated into a single 'web of interaction' which provides a comprehensive understanding of the issues and guides us towards identifying the solutions.

We use a worked out example of a case of tuberculosis to demonstrate the use of this approach and develop a rich web of interaction, which is then linked to identification of possible approaches towards mitigating the impact of disease on the individual and the family. Some suggestions to the departments of community medicine on organizing family studies are also provided.

Availability of a systematic and comprehensive approach would improve students' understanding of the social model of disease and multifactorial causation of disease. It will also provide a standardized method of teaching this important component of community medicine nationally.